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Benchmarking Utilizing the Cardiac Arrest Registry to Enhance Survival (CARES)
Surveillance Database
Bryan McNally, MD, MPH, Comilla Sasson, MD, MS, Allison Crouch, MPH, Amanda Bray-Perez, BS, Arthur Kellermann, MD, MPH
BACKGROUND
•Among victims of out-of-hospital cardiac arrest (OHCA)
who are witnessed to collapse and are found in ventricular
fibrillation, reported rates of Utstein survival* range from
2% in Detroit (2004) to 46% in Seattle (2006).
•Nationwide, the overall median reported survival rate for
all cardiac arrests (witnessed and unwitnessed) is 6.4%.
•In 2008 the American Heart Association (AHA)
recommended that OHCA be made a reportable event and
recommended that any surveillance system designed to
monitor OHCA should collect data on hospital outcomes
•CARES is a model OHCA surveillance registry that is
designed to enable communities of any size to collect data
on cardiac arrest events, ascertain outcomes, and use this
information to improve the quality of emergency cardiac
care.
•CARES collects and links data from three complimentary
sources – 911 dispatch, EMS providers, and hospitals
•The resulting registry can be used to describe the local
epidemiology of OHCA, assess the timeliness of key
interventions, and ascertain rates of survival to hospital
discharge
•Benchmarking an EMS system in relation to national
statistics can help identify areas of variation and quality
improvement.
OBJECTIVE
To utilize a national surveillance registry to benchmark the
performance of a large, urban county, with regional and
national statistics.
METHODS
1. A secondary analysis of data prospectively submitted to the
Cardiac Arrest Registry to Enhance Survival (CARES)
between October 1, 2005 to November 30, 2008 was
conducted.
2. Descriptive statistics were determined for:
• Fulton County (Atlanta, Georgia)
• Region III - Seven out of the eight counties that comprise
metropolitan Atlanta (including Fulton County)
• The current CARES national registry includes all out-ofhospital cardiac arrest cases from 15 U.S. cities including:
Anchorage, Alaska
Atlanta, Georgia
Austin, Texas
Baytown, Texas
Boston, Massachusetts
Cincinnati, Ohio
Columbus, Ohio
Houston, Texas
Kansas City, Missouri
Nashville, Tennessee
Oakland County, Michigan
Raleigh, North Carolina
Sioux Falls, South Dakota
Springfield, Massachusetts
Ventura County, California
RESULTS
RESULTS
• The table provides comparison of summary data for all three sites (Fulton
County, Region III, and National).
• Of 9,295 cases of out-of-hospital cardiac arrests of presumed cardiac
etiology, the overall national rate of survival to hospital discharge was 7.8%,
which is comparable with other large national databases.
Site
Number of
Cases
Overall
Survival %
Utstein
Survival %
Utstein
Bystander
Survival %
AED Use %
Bystander
CPR %
Fulton
County
1645
4.1
15.5
20.0
3.6
19.9
Region III
3606
4.9
13.9
18.9
2.6
20.8
National
9295
7.8
24.9
29.3
3.4
24.8
*Definitions for the metrics in the table include:
• Overall Survival: Survival for all attempted resuscitations of cardiac etiology.
• Utstein Survival : Survival for patients with the greatest likelihood of having
a successful resuscitation - those that have a witnessed arrest by bystanders
who are found in a shockable rhythm.
• Utstein Bystander Survival: Survival of Utstein patients who have had some
bystander intervention (CPR by bystander and/or AED applied by bystander)
• AED use: The percent of cardiac arrest patients that have an AED applied by
a bystander prior to EMS arrival.
• Bystander CPR: The percent of cardiac arrest patients that receive CPR by a
bystander prior to EMS arrival.
LIMITATIONS
• As the CARES program expands, sites are added to the registry on an ongoing
basis. Therefore, not all of the sites that were included in this analysis
contributed data through the entire date range.
•Determining that cardiac arrest is due to heart disease is subjective.
In general, OHCA is ascribed to heart disease unless there is an obvious
alternate cause, such as major trauma, drowning, electrocution, drug overdose,
asphyxia, or exsanguinations. Because few victims are autopsied, it is often
impossible to assign a definitive cause of death.
CONCLUSIONS
•CARES is designed to enable EMS systems of any size to measure their
performance relative to national guidelines, and link prehospital care to hospital
outcomes. Using CARES, communities may identify opportunities to improve
the delivery of care and hopefully, increase rates of survival.